Seventy patients with idiopathic syndromes were treated with
maprotiline, a
noradrenaline reuptake inhibitor, or
clomipramine, a
serotonin reuptake inhibitor in a 6-week, double-blind, randomized, multicenter trial. Fifty-two patients completed the double-blind phase. Overall, 50% of the patients improved. Significant decreases were seen not only in the levels of
pain but also in bodily discomfort, sadness an inner tension (determined by visual analogue scales, VAS). A decrease was also found in the frequency of sleep disturbances, intellectual and emotional inhibition, irritability, guilt feelings, retardation, sadness and suicidal ideas (observed ratings). Sixty-three percent of the subjects showed an overall improvement during treatment with
clomipramine as compared to 36% during treatment with
maprotiline (p less than 0.05). During
clomipramine treatment significant decreases were seen on all the six VAS: sadness, bodily discomfort, inner tension, concentration difficulties, memory disturbances and
pain. Bodily discomfort and
pain were significantly reduced during
maprotiline treatment. The effects produced by
clomipramine were also significantly greater than the effects caused by
maprotiline as concerns psychic anxiety and inhibition (VAS). The overall reduction in VAS was significantly greater with
clomipramine when compared to
maprotiline. The most important side effects were dry mouth (both drugs) and sweating (
clomipramine). However, in the
clomipramine group, 8 patients were excluded due to side effects as compared to 1 patient in the
maprotiline group. Thus, the results indicate that
antidepressants reduce not only
pain but are also of clinical value in the treatment of patients with idiopathic
pain syndromes. Drugs with pronounced effects on the
serotonin reuptake are to be preferred.